title: Cost-utility analysis of a collaborative care intervention for major depressive disorder in an occupational healthcare setting.
abstract: OBJECTIVE
  Major depression is associated with high levels of absence and reduced productivity. Therefore the costs to society are high. The aim of this study was to evaluate the cost-utility of collaborative care for major depressive disorder (MDD) compared to care as usual in an occupational healthcare setting. A societal perspective was taken.
  
  
  METHODS
  In this randomised controlled trial, 126 sick-listed workers with MDD were included (65 collaborative care, 61 care as usual). Baseline measurements and follow up measures (3, 6, 9 and 12 months) were assessed by questionnaire. We applied the Trimbos/iMTA questionnaire for costs associated with psychiatric illness, the SF-HQL and the EQ-5D respectively measuring the health care utilization, production losses and general health related quality of life.
  
  
  RESULTS
  The average annual healthcare costs in the collaborative care group were €3,874 (95 % CI €2,778-€ 5,718) compared to €4,583 (95 % CI €3,108-€6,794) in the care as usual group. The average quality of life years (QALY's) gained were lower in the collaborative care group, 0.05 QALY. The majority of the ICERS (69 %) indicate that collaborative care is less costly but also less effective than care as usual. Including the productivity costs did not change this result.
  
  
  CONCLUSIONS
  The cost-utility analysis showed that collaborative care generated reduced costs and a reduction in effects compared to care as usual and was therefore not a cost-effective intervention.
authors.affiliation: Institute for Medical Technology Assessment, Institute of Health Policy and Management, Burgermeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands, Goorden@bmg.eur.nl.
authors.forename: Maartje
authors.initials: M
authors.lastname: Goorden
authors.forename: Moniek C
authors.initials: MC
authors.lastname: Vlasveld
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.forename: Rob
authors.initials: R
authors.lastname: Hoedeman
authors.forename: Christina M
authors.initials: CM
authors.lastname: van der Feltz-Cornelis
authors.forename: Leona
authors.initials: L
authors.lastname: Hakkaart-van Roijen
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy*; D017598:Efficiency, Organizational; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D009426:Netherlands; D009786:Occupational Health Services / Q000191:economics*; D011788:Quality of Life; D018582:Sick Leave; D011795:Surveys and Questionnaires